Changing Patterns in Medication Use with Increasing Probability of Death for Older Medicare Beneficiaries

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The Issue

Managing prescription drug use as elderly adults approach the end of life is a little-studied but key element of providing quality care. One major concern is the overprescribing of chronic care medications that have minimal short-term benefits and the underprescribing of palliative drugs that can ease pain and manage symptoms. In this Commonwealth Fund–supported study, the authors examined patterns of palliative and chronic care medication use in elderly Medicare beneficiaries as the probability of death increased.

What the Study Found

The authors used data that followed community-dwelling Medicare beneficiaries age 65 and older for six years. They created a model to predict probability of death and divided the respondents into seven groups, ranging from less than 5 percent probability of death to greater than 50 percent. They then measured each group's prevalence and intensity of use of palliative medications (e.g., antidepressants and sleep aids) and chronic care medications (e.g., statins). The use of chronic medications decreased as the probability of death increased, although intensity of use generally remained constant. However, contrary to the researchers' expectations, the use of palliative medications increased from the lowest (i.e., lowest probability of death) group to the next-higher group, and then remained constant before dropping off at the highest (i.e., highest probability of death) level.

Conclusions

Appropriate end-of-life care requires a critical review of medication use. Further research is needed in order to establish appropriate medication guidelines and treatment plans.